Care Management at Home
Care Management at Home
We make aging in place possible.
Most people will tell you they want to remain in their homes until the day they die. This is commonly referred to as aging in place.
Many times, aging in place is possible. Even very frail individuals can be supported at home, in the right setting, with a team to meet their needs. A well-coordinated team with the right combination of professionals, family and/or private duty caregivers, make aging in place possible, eventually shifting from best practices aggressive medical care to comfort care with hospice.
We partner with the client and their decision-maker, establish the team, coordinate the services, monitor for emerging needs, anticipate and plan for the next steps, and focus on what makes the client happy.
We address all the details.
We manage the details of aging in place. We take clients to physician appointments, provide medication management, and connect the client to needed resources. We do this as a partner with the client and family or authorized decision-maker. Most of all we are advocates.
When aging in place is not the long term answer we partner with decision-makers and help them navigate the options. For example, some clients cannot tolerate having private duty caregivers in their homes and view them as intruders. We know one case where a woman asked her caregiver to go out and get the mail and then closed and locked the door behind her!
Some clients love to argue and become too much for just one caregiver at a time. In other situations, clients become aggressive or become wanderers, unsafe in the home setting.
We manage the transitions.
Sometimes, aging in place is not possible. In these cases, we help with the transition to an assisted living community or a memory care community. These settings offer more support without having a caregiver always in their line of sight.
Some clients are able to age in place long after they have the cognitive ability to manage their own lives. Friends and neighbors can help out by supplying food, helping with medication, providing rides, running interference, and providing advice.
Cognitive decline in the area of executive function can be reflected by the state of the home. Some clients who have had piles of unopened mail, food far past the expiration date, soiled clothes, linens and carpets, and non-functioning appliances, have needed capacity evaluations and ultimately needed a power of attorney agent enacted or a court-appointed guardian/conservator.
Care managers meet the client where they are and partner with the client and their decision-maker to help the client live their best life, whether aging in place or another option is the best option.